title: Utilization of mechanical ventilation for asthma exacerbations: analysis of a national database.
abstract: BACKGROUND
  The current frequency of noninvasive (NIV) and invasive mechanical ventilation use in asthma exacerbations (AEs) and the relationship to outcomes are unknown.
  
  
  METHODS
  We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample to identify patients discharged with a principal diagnosis of AE. For each discharge, we determined whether NIV or invasive mechanical ventilation was initiated during the first 2 hospital days. Using multivariate logistic regression to adjust for potential confounders, we determined whether use of mechanical ventilation and in-hospital mortality changed between 2000 and 2008.
  
  
  RESULTS
  The number of AEs increased by 15.8% from 2000 to 2008. The proportion of admissions for which invasive mechanical ventilation was used during the first 2 days decreased from 1.4% in 2000 to 0.73% in 2008, whereas NIV use increased from 0.34% to 1.9%. The adjusted mortality from AEs requiring NIV or invasive mechanical ventilation was unchanged from 2000 to 2008. The hospital stay was also unchanged.
  
  
  CONCLUSIONS
  There was a substantial increase in the use of mechanical ventilation, accompanied by a shift from invasive mechanical ventilation to NIV. Although we could not determine the clinical reasons for this increase, hospital stay and mortality were unchanged. A randomized trial is needed to determine whether NIV can improve outcomes in AEs before widespread adoption makes it impossible to conduct such a trial.
authors.affiliation: Milwaukee Initiative in Critical Care Outcomes Research (MICCOR) Group of Investigators.
authors.forename: Rahul
authors.initials: R
authors.lastname: Nanchal
authors.forename: Gagan
authors.initials: G
authors.lastname: Kumar
authors.forename: Tillotama
authors.initials: T
authors.lastname: Majumdar
authors.forename: Amit
authors.initials: A
authors.lastname: Taneja
authors.forename: Jayshil
authors.initials: J
authors.lastname: Patel
authors.forename: Gaurav
authors.initials: G
authors.lastname: Dagar
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Jacobs
authors.forename: Jeff
authors.initials: J
authors.lastname: Whittle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000401:mortality* / Q000628:therapy*; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000639:trends*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: asthma; intensive care unit; mechanical ventilation